Transtornos depressivos na doença de Parkinson de início precoce

Abstract

Parkinsons disease (PD) is characterized by motor symptoms, such asbradykinesia, rest tremor, rigidity and postural instability. However, non-motor symptoms have been emphasized due to their high frequency and impact in patients life. Early-onset PD (onset before 50 years old) have some clinical, genetic and neuropathological specificities. Few studies investigated psychiatric disorders in earlyonset PD. The objectives of the present study are to verify the frequency of depressivedisorders in this population and to assess possible clinical and sociodemographic associated variables. Psychometric properties of the instruments used to assess depressive symptoms were analyzed. It was also evaluated other psychiatric disorders and risk of suicide. A cross-sectional study was performed including psychiatric and neurologic examination in 48 consecutive individuals with disease onset before 50 years of age (M/F; 28/20). Mini-Plus, BDI and Ham-D were the psychiatric tools used, while UPDRS, HY and SES were the neurologic ones. Patients had a mean age (± SD) of 50 years-old (± 8.0); mean age of onset (± SD) of 40.5 (± 7.4); mean UPDRS score (± SD) of 46.5 (± 22.6); mean HY stage (± SD) of 2.2 (± 0.6) and mean SES score (± SD) of82.7 (± 12.1). Only 60.4% of patients were in use of l-dopa, with a mean daily dosage (± SD) of 634.9 mg/day (± 281.1). Half of patients exhibited a depressive disorder at the moment of the examination; 37.5% of them had major depression. Anxiety disorders were present in 66.7%; social phobia, in 54.2%; generalized anxiety disorder, in 31.3% and 8.3% had panic disorder. Obsessive compulsive disorder occurred in 10.4% andpsychosis in 6.3%. Patients with depressive disorders (major depression and dysthymia), when compared to non-depressed patients, scored higher in total UPDRS, UPDRS-I, UPDRS-II, BDI and Ham-D. They also had more anxiety disorders, such as panic disorder and social phobia. Female gender, lower educational level and onset of motor symptoms on right side of the body were associated to greater severity of depressive symptoms. The best cut-off point for BDI (16, as calculated by ROC curve) had 70.8% of sensibility and 83.3% of specificity. The area under ROC curve was 0.869, indicating good discriminative properties. BDI and Ham-D had a good positive correlation. This study emphasizes that depressive disorders are very common in earlyonset PD, similar to what occurs in PD with later onset. Nevertheless, depressive disorders in PD are frequently underrecognized or undertreated, despite its relevantfunctional impact. BDI may be an instrument of great clinical utility in recognizing depression, and Ham-D, in assessing its severity.